System and method for delivering a substance to a body cavity

ABSTRACT

A system and method for creating a medicated atmosphere in an organ, or body cavity is disclosed. The system includes a flexible aerosolization catheter that can be manipulated during use, a device for the introduction of the aerosolization catheter, a medication delivery apparatus configured to control delivery of a medication to the catheter, a gas delivery apparatus in communication with the catheter, a gas pressure relief apparatus configured to relieve pressure in the organ or body cavity, and a central controller. The method includes providing insufflation gas and an aerosol of medication to an organ or body cavity while controlling overall pressure in the organ or cavity. The method may also include re-entering a patient through at least one port to apply gas and an aerosolized medicament, in either a post-operative procedure or in a chemotherapy context.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of application Ser. No. 10/961,475,filed Oct. 7, 2004, now U.S. Pat. No. 7,704,223, which claims thebenefit of U.S. Provisional Application 60/509,733, filed Oct. 7, 2003,and the entirety of each of these applications is incorporated herein byreference.

FIELD OF THE INVENTION

The present invention relates to a system and method for delivering asubstance to a body cavity. More particularly, the present inventionrelates to a system and method for delivering a substance to a bodycavity in conjunction with a minimally invasive operative procedure orfor therapeutic treatment unrelated to a surgical procedure.

BACKGROUND

Among problems that physicians have encountered during diagnostic orsurgical procedures, using both “open” techniques, and minimallyinvasive (laparoscopic) surgical techniques, are numerous postprocedural complications. These complications can consist of, but arenot limited to, post operative pain, infections, tissue adhesions, andtumor formation. Numerous products, such as medications and associateddelivery systems, addressing these issues exist on the market to improvethe surgical or invasive experience and patient outcomes. Among theseproducts are suction and irrigation wands that are used for flushingtissue sites with sterile water or saline and removing blood. There aremedications, which are spread over exposed organs, to coat or provide abarrier between tissue and organs for prevention of adhesions. Thesematerials may be in gel form, sheet form, spray (liquid) form, oraerosol form to coat organs or tissues, or to provide thin layerdeposition to the organs in the operative site. Some of these materialsmay be used in both open and minimally invasive surgical techniques.

The problems with these materials, and their application as related tolaparoscopy, are their inability to be used easily and effectively in aminimally invasive laparoscopic environment. Among the difficultiesassociated with spraying of liquids, is the pooling and lack ofcontainment of the fluids used with irrigation and aspiration wands. Itis also difficult to cover large areas (greater than several squarecentimeters), and do so without using much more medicament than isnecessary. This contributes to the cost of excessive medication, andadding to the cost and time of the surgery.

Materials used in sheet form are not practical to apply to the organswhen using laparoscopic minimally invasive techniques, due to thedifficulty in getting the material through standard trocars, and thenspreading the material out over the affected area, and keeping it inplace once positioned. The liquid spray technique has many of the sameproblems as the irrigation approach. These devices normally force aliquid through a cannula like device under pressure. The introduction ofadditional fluid into the body cavity can cause increases in pressureand do not include a means for pressure relief. Without a means fordirecting the spray, it is difficult to control where the medication isdeposited, and in what amount. Also, the precise disposition of themedication as to amount and location is difficult to control.

Compound materials are sometimes mixed prior to being aerosolized by ahand held syringe device, and then by applying an air stream to themixed medication as it is being dispensed, to create an aerosolizedstream that is used to “paint” the organs. This method also ignores theproblem of the creation of additional pressure in the organ with norelief mechanism. Creating an aerosol “cloud” contends with the problemof how to effectively coat all the surfaces required, but alsointroduces the problem of increasing abdominal pressures uncontrollablyinside an insufflated body cavity or organ, such as the peritoneum.

All of the above methodologies, while focused on applying substances indifferent physical forms for the purpose of treating or coating tissuesand/or organs, have not been optimized for use in the laparoscopic,minimally invasive environment. The term “substance”, as used in thisspecification, includes, without limitation, a liquid, powder or gas, orany combination thereof.

BRIEF SUMMARY

In order to address the deficiencies in the prior art, a system andmethod for providing a substance to a body cavity is discussed below.According to a first aspect of the invention, a system is provided thatwill allow the application of a substance, such as an aerosolizedmedicament to a distended body cavity that will allow for the efficient,safe, and effective application of any number of substances, such asaerosolized liquids, which can be used for pain management (analgesics),infection prevention (prophylactic antibiotics), tissue adhesion (anynumber of formulations can be used including naturally occurringlubricious medications such as hyaluronic acid, or any number of othermedicaments such as heparin, glycerin or glycol medications, or evenhumidity), and tumor prevention (using targeted or prophylacticchemotherapy drugs or methods). A pressure relief or maintenance devicecontrollably keeps the pressure within a desired range, compensating forthe introduction of substances into the body cavity that can build upunwanted pressure. A central controller in communication with asubstance introducing device and an insufflator may coordinate all ofthe parameters of pressure, flow, temperature and so on.

According to another aspect of this invention, a method for providingcontinued or postoperative application of a substance, by re-institutingan environment in the patient in which subsequent applications ofmedication may be administered, is disclosed. The method includesproviding a patient with a port or other device that will fasten to theouter abdomen wall and the interior abdomen wall to provide a passageinto a body cavity of a patient. A supply of insufflation gas isprovided through the port and a substance is introduced, for example inaerosol form, into the body cavity through the port. In one embodimentthe substance is introduced via a nebulizing catheter. In oneembodiment, the method may relate to a therapeutic treatment forcancerous tumors and the substance supplied to the body cavity may bechemotherapy medication. In another embodiment, the method may berelated to post-operative pain or infection treatment, such as theapplication of analgesic or antibiotic substances, respectively.

In yet a further aspect of this invention a method and system aredisclosed that improve upon typical methods of applying medications toan insufflated organ by controlling and coordinating the requirements ofpressure maintenance and relief within the organ, coordinating theapplication of the aerosolized medicament within the patient (includingthe amount, rate of application, timing of the administration of themedicament, and control of the direction or formation of an optimizedaerosolized laparoscopic medicated environment), maintaining properdistention for visualization and operative manipulation of instruments,and providing feedback (visual and or audible) on the information ordata required for controlling the operative, diagnostic, or postoperative treatment of a patient.

Further aspects and advantages of the invention are discussed below inconjunction with the preferred embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an embodiment of fluid connections in a system forlaparoscopic delivery of aerosolized medication according to oneembodiment of the present invention.

FIG. 2 is a perspective view of a nebulizing catheter suitable for usein the system of FIG. 1.

FIG. 3 is an alternative embodiment of the nebulizing catheter of FIG.2.

FIG. 4 is an alternative embodiment of the system of FIG. 1.

FIG. 5 is a schematic view of an embodiment of control connections ofthe system of FIG. 1.

FIG. 6 is a block diagram of a regulated liquid and gas dispensingcontroller suitable for use in the system of FIG. 1.

FIG. 7 is a block diagram of an alternative embodiment of the regulatedliquid and gas dispensing controller of FIG. 6 having a fluid mixingchamber for dispensing and mixing multiple fluids.

FIG. 8 is a block diagram of a second alternative embodiment of theregulated liquid and gas dispensing controller of FIG. 6 having a y-tubefor dispensing and mixing multiple fluids.

FIG. 9 is a block diagram of a third alternative embodiment of theregulated liquid and gas dispensing controller of FIG. 6 having a gasmixing chamber for providing a mixed insufflation gas.

FIG. 10 is a block diagram of a disposable catheter, syringe and tubingset attached to the regulated liquid and gas dispensing controller ofFIG. 6.

FIG. 11 is a perspective view of a syringe pump having a receiving slotfor a disposable syringe/catheter/tubeset.

DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS

Referring to FIG. 1, an embodiment of a system 10 for delivery of asubstance to a body cavity is shown connected to a patient 12. Thesystem 10 includes an insufflator 14 for providing a supply ofinsufflation gas to the patient 12. The system also includes a pump 16configured to controllably supply a medicament to the patient 12. Theinsufflator 14 connects to gas delivery lines 18 and then to one or morecatheters 20, 22. The insufflator 14 may include an integrated gastemperature control mechanism or may be combined with one or morein-line gas heaters to control the temperature of gas supplied forinsufflation and/or nebulization. A first catheter is an insufflationcatheter 20 sized for cooperating with a trocar 21 or other standardcatheter insertion needle so that the insufflation catheter may bedirected into the peritoneum or other specific location in the patient12. A pressure relief control valve 24 is positioned along the supply ofinsufflation gas, for example on the catheter 20 or trocar 21, so thatpressure in the peritoneum or other target location in the patient willbe monitored and adjusted to maintain a desired level.

An aerosolization gas supply, preferably separately controllable fromthe general insufflation gas sent through the gas delivery line 18 tothe nebulization catheter 22, is also supplied by the insufflator 14.This aerosolization gas supply is directed through a gas line 18connected to a nebulization catheter 22 inserted into the peritoneumthrough another trocar 23 or other suitable needle. Although the system10 may operate with a single pressure relief control valve positionedanywhere along the components making up the insufflation gas supplychain, a separate and independently controllable pressure relief valve25 may be positioned on the nebulization gas supply, such as at thetrocar 23 for the nebulization catheter 22. The nebulization catheterreceives a medicament in fluid form from fluid supply line 26 connectedwith the pump 16. The gas provided to the nebulizing catheter is mixedwith a fluid medicament supplied by the pump 16 and generates anebulized medicament for deposit on specific organs, on the peritoneumcavity wall and other locations within the patient 12. The system ofFIG. 1 is shown with only the basic fluid and gas lines for clarity. Acentral controller, described in greater detail below, coordinates theactions of the insufflator, pump, and pressure relief control valve(s)so that any of the system parameters, such as pressure, gas or fluidflow rate, temperature and so on, may be managed. Although a nebulizingcatheter is shown, any of a number of other devices for introducing asubstance into a body cavity may also be used. For example, thenebulizing catheter 22 may be replaced by a suction irrigation wand toinfuse the body cavity with a substance.

The insufflator 14 may be any of a number of insufflators, such as theOMNIFLATOR Model 6620 available from Northgate Technologies, Inc. ofElgin, Ill. Examples of suitable insufflators are described in U.S. Pat.No. 6,299,592 and U.S. application Ser. No. 10/829,485, and the entiretyof each of these references are incorporated by reference. Theinsufflator may include a pressurized source of insufflation gas.Examples of insufflation gases include, but are not limited to, carbondioxide, nitrous oxide, argon, or helium. The insufflation gas istypically reduced in pressure by the insufflator to approximately 45 to55 millimeters of mercury (also know as a “push” pressure), although thepressure may be changed depending on the insufflator in use and anyregulations that may be in force. While the push pressure may be in therange of 45-55 millimeters of mercury, the actual pressure maintained inthe peritoneum or other body cavity is preferably less than 25-30 mm ofmercury and, in the case of many laparoscopic surgeries, most preferablyin the range of 12 mm of mercury.

The pump 16 may be a peristaltic pump, syringe pump, hydraulic (air overliquid) pump or any other mechanism capable of controlling thedispensing of medication. Controllable pump parameters may include therate and volume, as well as the timing, of delivery. It is contemplatedthat continuous and periodic pumping may be desired. Delayed pumping ofmedication, such as the transport of medication to the nebulizationcatheter 22 at predetermined times for predetermined intervals is alsocontemplated. In one embodiment, the pump may include a heatingmechanism to heat the fluid to a controlled temperature prior todelivery to the fluid line 26 and nebulizing catheter 22.

The gas and fluid lines 18, 26 may be constructed from disposablepolyvinyl chloride tubes, although in other embodiments any suitablematerials may be used. For example, the tubing may be made of a siliconematerial that is reusable. The diameters of the tubes may be varieddepending on flow rate requirements and any regulations that are inforce. Also, the inner diameter of each of the tubes may be differentfrom each other. A filter (not shown) may be located in each of thetubes used for the gas lines 18 to provide a particulate barrier. In oneembodiment, the filter may be a glass-fiber hydrophobic filter thatprovides a particulate barrier of approximately 0.2 microns and operatesat a ninety-nine percent rate of efficiency. In other embodiments anynumber of commonly used filters, with different filtering capabilities,may also be used.

The pressure relief valves (PRV's) 24, 25 associated with theinsufflation and aerosolization gas supplies, respectively, may belocated within the gas supply lines 18 or the catheters 20, 22. In otherembodiments the valves 24, 25 may each be a discrete valve such ascommonly available from Pneutronics, a division of Parker HannifinCorporation of Cleveland, Ohio. Any of a number of types of valves maybe used. For example, the valve may be operated electrically,pneumatically, or hydraulically. In other embodiments, the valve may bea mechanical pressure relief valve preset to relieve pressure once apreset maximum has been reached. For example, when the pressure of theinsufflation gas reaches a preset pressure, a spring operated valveopens and provides pressure relief. Preferably, the valve is operated bya signal generated by a controller associated with the electronics ofthe insufflator. An example of such a controller is contained within thecontrol circuitry of the Northgate OMNIFLATOR 6620 Insufflator, and anexample of such a valve is a pinch valve. The signal is generated viafeedback due to the monitoring of flow restriction or back pressuresensed by a central controller 130 (See FIG. 5). The monitoring of thepressure of the insufflation gas is accomplished via a pressuretransducer (not shown) in the controller 130 that monitors the pressure.

The nebulizing catheter 22 preferably includes a combination of at leastone fluid lumen and at least one gas lumen oriented to mix the gas andfluid to generate an aerosol mist inside the peritoneum. Any of a numberof nebulizing catheters may be utilized, such as those described in U.S.Pat. No. 5,964,223, issued Oct. 12, 1999 and entitled “NebulizingCatheter and Methods of Use and Manufacture”, the entirety of which isincorporated by reference herein. Some examples of nebulizing cathetersare shown in FIGS. 2-4.

FIG. 2 shows a nebulization catheter 30 with a distal end that can belocated inside of a peritoneum via a trocar. The nebulization catheter30 has a coaxial tubular arrangement with an outer tube 32 surroundingan inner tube 34 so that a fluid delivered from a distal liquid orifice36 of the inner tube 34 is nebulized by the flow of a pressurized gasdelivered in a distal direction from the annular region between theinner and outer tubes at the distal orifice 38 of the outer tube 32. Inaddition, another lumen 40 extends through the shaft of the nebulizationcatheter 30. This additional lumen 40 connects to a distal tubularextension 42. The tubular extension 42 extends distally of the distalend of the nebulization catheter 30. A distal end 44 of the distaltubular extension 42 curves back on itself so that a distal orifice 46of the tubular extension 42 is oriented in a proximal direction back atthe orifices 36 and 38 of the inner and outer tubes.

The additional lumen 40 also carries a pressurized gas which is directedin a proximal direction by the orifice 46 against the direction of theaerosol plume generated by the gas and liquid exiting the orifices 36and 38. The gas from the additional lumen 40 presents a counterflow tothe gas from these orifices thereby slowing down the velocity of theparticles generated from these orifices. In a preferred embodiment, thedistal tubular extension 42 may be formed of a suitable material such asstainless steel needle stock.

FIG. 3 shows another embodiment of a nebulizing catheter 50 thatincorporates a counterflow arrangement. Like the embodiment describedabove, in this embodiment the nebulizing catheter 50 may be positionedin a trocar. The nebulization catheter 50 has a distal section 52 thatcurves back on itself. The nebulization catheter 50 has distal orifices54 and 56 that generate a plume of nebulized particles in a reverse,i.e. proximal, direction. Also located in the nebulization catheter 50is another lumen 58 for carrying a pressurized gas. The additional lumen58 has a distal orifice 60 oriented in a distal direction. The distalorifice 60 of the additional lumen 58 is aligned with respect to thedistal orifices 52 and 54 of the nebulization catheter 50 so that theflow of gas from the additional lumen 58 slows down the velocity of thenebulization plume generated from the nebulization catheter 50. Theaerosol plume generated by the nebulization catheter reverses directionand is delivered to the peritoneum carried by the flow of gas from theadditional lumen 58.

In another embodiment of a nebulization catheter arrangement, thecatheter may include three lumens, two gas and one liquid, where thesecond of the two liquid lumens is utilized to sense pressure and/orprovide pressure relief to the body cavity.

Referring to FIG. 4, an alternative embodiment of the system 100 isshown. In this embodiment, the system 100 provides both the insufflationgas and the aerosolization gas through a single gas line 118 that isrouted through the nebulization catheter 122 via the trocar 123 or otherneedle inserted into the patient 112. A combined insufflator/pump 114provides both the insufflation gas and the fluid through the nebulizingcatheter 122. The fluid is provided along a fluid line 126 that may passthrough an optional heating sleeve 127 controlled by a heater controller128 to warm the fluid to a desired temperature. In an alternativeembodiment, the fluid heating mechanism may be integral with the pump orprovided by an in-line heater. In another embodiment, where the pump isa syringe pump for controlling fluid discharge from a removable syringe,heat may be supplied to the fluid using syringe heater tape availablefrom Watlow Electric Manufacturing Co. of St. Louis, Mo. The heater maybe controlled through a central controller at the combinationinsufflator/pump 114. The temperature of the fluid is preferablyadjusted such that heat loss in the remaining path to the body cavity isaccounted for so the fluid is within the desired temperature range as itenters the body cavity. A relief valve mechanism 125 is provided tocontrol the gas pressure so that the gas pressure in the peritoneum orother body cavity is maintained at a desired level. The pressure reliefvalve 125 may be integrated with the trocar or may be a separate reliefvalve mechanism positioned along the gas line 118 or in the insufflator.As illustrated in FIG. 4, the system 100 may include combined orseparate gas and fluid sources. Additionally, the system may workthrough a single trocar 123 or through separate trocars as isillustrated in the embodiment of FIG. 1.

As shown in FIG. 5, the system 10 of FIG. 1, is preferably controlled bya central controller 130 which may be integral with, or separate from,the insufflator 14. The insufflator may also include a display 132 forsimultaneously or selectively displaying one or more of the parametersmanaged by the central controller 130. Preferably, the centralcontroller 130 is in communication with each of the components of thesystem, whether integrated with the insufflator 14 or discrete. Thus,the central controller 130 may monitor and adjust the temperature andhumidification control of the insufflation and catheter gas via the gascontroller 134, the operation of the pump 16 providing medication to thecatheter and the controller 136 connected with the pressure relief valveor valves on the insufflation gas supply and/or the catheter gas supply.One or more of the controllers 130, 134, 136 and the display 132 may beintegrally formed with, or independent of, the insufflator 14. Thedisplay may be provided with one or more standard interface buttons, ora touch screen capability. Any of a number of communication protocolsand formats may be used between the central controller 130 and any ofthe integrated or discrete controllers.

A more detailed diagram of an embodiment of a regulated liquid and gasdispensing controller 150 incorporating a syringe pump, independent CPUand optional active pressure relief mechanism as shown in FIG. 6. Thecontroller 150 combines insufflator and pump controller tasks. In oneembodiment, the controller is preferably configured in a high pressure,low flow arrangement that differs from the typical low pressure, highflow arrangement of insufflators generally. Insufflation gas from a highpressure gas source, such as pressurized bottled gas, is connected atthe gas inputs 152. A high pressure manifold 154 regulates the pressurefrom the initial high pressure source, in which gas can be at a pressurein the range of 2000 p.s.i., and reduces the supply pressure through ahigh pressure regulator 156. In one embodiment, the high pressureregulator 156 reduces the received gas pressure to approximately 150p.s.i. Any of a number of types of high pressure regulators may be used.

The pressure of insufflation gas supplied to a patient generally needsto be at a lower pressure and so the gas from high pressure manifold at,for example, 150 p.s.i. is then processed through a low pressuremanifold 158. The low pressure manifold includes a low pressureregulator 160 configured to further reduce the gas pressures. In thisexample, the gas pressure is reduced from 150 p.s.i. to 100 p.s.i. Thispressure translates to a flow rate of 2-3 liters per minute actuallyintroduced to the body cavity due. The pressures discussed above aremerely presented as examples and the various pressure settings in thehigh and low pressure manifolds may be user adjustable, or may be presetat the manufacturer with no manual settings necessary, at any of anumber of pressures. The low pressure manifold also includes a passivepressure relief valve (PRV) 162 set to mechanically release pressureabove a predetermined threshold which, in this example, is 0.9 poundsper square inch gauge (p.s.i.g.). An electrically controllable outputvalve 164 meters the gas output sent on to a catheter. Pressure monitorlines connect a central processor (CPU) 166 to the low pressure manifoldvia high pressure sensors 168. When used in an insufflator arrangement,at least one of a passive pressure relief valve 24 (See FIG. 1) at thepatient may be used to control the pressure introduced to the patient,or the optional active pressure controller 194, described in more detailbelow, may be utilized. The syringe pump motor controller 170 is alsocontrolled by the CPU to meter the amount of fluid provided to apatient.

An actuator 192 may be connected with the controller 150 to initiate oneor more actions by the controller 150. For example, the actuator 192 maysend a signal to the CPU 166 that will start or stop the production ofinsufflation gas, the dispensing of fluids or other activities. In oneembodiment, the actuator 192 may be a foot pedal or some other form ofactuator that allows a medical practitioner to keep both hands free.Push buttons, levers, touch-screens or any of a number of actuationinput means are also contemplated.

An optional portion of the regulated liquid and gas dispensingcontroller is an active pressure controller 194 that, in addition to themechanical, passive pressure relief valve 162, can provide a mechanismfor limiting pressure supplied to the patient. Although optional, theactive pressure controller 194 can provide more precise pressure controlby taking a pressure measurement supplied from a sensor via an externalpressure sense line 196 at the patient's body and allowing the CPU 166to actively regulate the pressure. Pressure data may be provided to theCPU 166 by way of low pressure sensors 198. The active pressurecontroller can reduce the pressure supplied to the patient through oneor more active pressure relief valves electrically controllable by theCPU.

Some operative and post-operative therapies may require a mixture ofmore than one fluid. The fluid mixture can be achieved through a numberof minor modifications. One embodiment of a regulated liquid and gasdispensing controller 150 with multiple fluid sources is illustrated inFIG. 7. In the embodiment of FIG. 7, a mixture of fluids is provided bya configuration of the regulated liquid and gas dispensing controller151 that utilizes a fluid mixing chamber 172 to mix different fluidsprovided by separate syringes 174, 176. The motor controller 170interprets instructions from the CPU 166 to activate the separate motors178, 180 linked to push plates 182, 184 to engage the respectivesyringes 174, 176.

Upon a signal from the CPU 166 and motor controller 170, each motor 178,180 will move its push plate a certain metered distance and cause thesyringe to eject a measured amount of fluid into the fluid mixingchamber 172. Each motor 178, 180 may be instructed to move the same ordifferent amount depending on the desired mixture of fluids. Checkvalves 186, 188 may be included on the input ports of the fluid mixingchamber as added protection against back flow into the same or differentsyringe. In order to provide sufficient pressure to eject the mixture offluid from the fluid mixing chamber, such as a 20 p.s.i. or other lowpressure regulator, supply of gas from the low pressure manifold 159 istaken after the low pressure regulator 160 and further processed througha mixing chamber pressure regulator 190 down to, in this example, 20p.s.i. The gas is then transmitted to the fluid mixing chamber to propelthe mixed fluid to the catheter for nebulization in a body cavity, fortopical application or other application. Using this embodiment, thedifferent fluids can be administered in combination or consecutively,where a single fluid is sent through, and evacuated from, the mixingchamber before the next fluid is dispensed.

Another embodiment of a controller 202 configured for fluid mixture isshown in FIG. 8. In this embodiment, all the same components as in FIG.7 are identified with the same reference numbers. The embodiment of FIG.8 differs from that of FIG. 7 in that a passive y-tube 204 replaces thefluid mixing chamber 172 and fluid mixing chamber regulator 190 of FIG.7. Thus, the mixing of fluids and delivery of the fluid from thesyringes 174, 176 to the catheter takes place using the force of thepush plates 178, 180 on the syringes. The different fluids may becombined in the y-tube by simultaneously dispensing the fluids from thesyringes. Alternatively, the fluids may be dispensed consecutively or atwidely spaced time intervals depending on the application.

In addition to providing configurations of a controller for providing asingle type of fluid, or multiple types of fluids, embodiments of thepresent invention include configurations and methods for accommodatingmultiple different gases. In one embodiment, shown in FIG. 9, a modifiedhigh pressure manifold 208 and mixing chamber 210 in a controller 212may be used to replace the high pressure manifold 154 of FIGS. 6 and 7.The remaining components of the controller 212 in FIG. 8 identical tothose in FIGS. 6 and 7 retain the same reference numerals for clarity.Using the controller 212 of FIG. 8, a mixture of different insufflationgases 214, 216, 218 are processed in respective high pressure regulators220, 222, 224 to bring their pressures down to a lower pressure, 100p.s.i. in this example, more easily managed by the mixing chamber 210.The mixing chamber, an example of which is disclosed in U.S. applicationSer. No. 10/829,485 incorporated above, combines substantially evenamounts of the gases into a mixture that is then processed through thelow pressure manifold 158 as previously described. Examples ofapplications for mixed gas insufflation include the prevention ofacidosis through the addition of oxygen to the insufflation gas, thereduction of post-operative pain through the addition of helium oroxygen, and other such applications.

In another embodiment, the fluid pump assembly of the regulated liquidand gas dispensing controller, which includes the motor controller 170,motor 178, and push plate 182, may be adapted to work with a disposablecatheter, syringe and tubing set 226. As shown in FIG. 10, the setallows for increased isolation of any fluid from contact with the restof the controller 228. This is achieved by including a direct syringe230 to tube 232 to catheter 234 connection rather than a separate, fixedsyringe holder that encloses a syringe on the interior of the holder andattaches a tube to the outside of the syringe holder where fluidcontacts a conduit built into the holder between the syringe andcatheter or tube. To provide further isolation from contamination, thetube 236 or other conduit from the gas outlet of the low pressuremanifold to the catheter is also preferably part of the set 226.

FIG. 11 discloses a perspective view of a syringe pump assembly 250having a receiving slot 254 for a disposable syringe/catheter/tubeset.The catheter (not shown) may be preassembled as attached to the syringe252 and replaceably insertable with the syringe as the syringe is placeinto the receiving slot 254 the syringe pump assembly, or the cathetermay be separated from the syringe and still directly attached to thesyringe without any intervening, non-disposable lumen. The syringe pumpassembly 250 may be in communication with a remote processor or containits own processor for managing operation of the syringe pump and any gassupply that may also be incorporated. In one embodiment, the housing ofthe syringe pump assembly may also contain pneumatics for supplyinginsufflation/catheter gas so that all the elements of the regulatedliquid and gas dispensing controller discussed previously are maintainedin a single housing. In this embodiment, a catheter gas input port 256may be integrally formed in the assembly so that a gas may be providedto the catheter attached to a syringe mounted in the assembly. A passivepressure relief valve located at the patient may be used to controlinsufflation pressure or the assembly 250 may contain an active pressurerelief valve. In the embodiment where an active pressure relief valve isincorporated, a pressure sense port for communicating with a pressuresense line from a patient would also be integrated into the housing ofthe assembly.

Utilizing the integrated system or separate system components describedabove, a method of providing a substance, such as a nebulizedmedication, to a body cavity during a minimally invasive procedure isnow described. Although a laparoscopic procedure is specificallyidentified below, the applications of medication using this system caninclude administration of nebulized substances onto or into specificorgans and lumens in the body, as well as topical applications.Additionally, the systems and methods described herein are applicable tominimally invasive procedures generally. In many normal laparoscopicprocedures, such as for gall bladders, hernias, bowl resections andetc., a patient is placed in the prone position and sedated. Averres-type needle is placed in the patient to transport gas to thepatient and this verres needle is connected to the insufflator to pumpup the peritoneum. One suitable verres needle or, more generally,insertion device is disclosed in U.S. application Ser. No. 09/841,125,filed Apr. 24, 2001 and published on Dec. 5, 2002 as Pub. No. US2002/0183715, the entirety of which is incorporated herein by reference.The verres needle may then be removed and a trocar inserted through theneedle hole already made, while maintaining a supply gas in the cavity.Using the opening provided by the trocar, an endoscope is inserted sothat a physician may see inside the body. At this point, several othersmaller trocars may be inserted into the body for instruments to be usedas needed for the particular procedure.

Utilizing the system described above, the insufflation gas is preferablyheated and humidified, and an appropriate medicament treatment isapplied. For example, to avoid adhesion problems which may often occurin laparoscopic procedures, an aerosol can be provided via theaerosolization catheter to cover the exposed organs and wall of theabdomen. This anti-adhesion treatment may be repeated multiple timesduring a surgical procedure and be preprogrammed into the centralcontroller 130 of the system. During the procedure, the parametersrelating to the delivery of gas and fluid may be displayed andindividually controlled. The parameters may include humidity,temperature, pH, volume, rate, pressure, and duration of any of thefluid or gas being injected into the patient. The pH may be adjusted by,for example, the introduction of acid or buffer solutions to the fluid.While any of a number of catheters may be used with the variousembodiments of the regulated liquid and gas dispensing controller toapply a medication, or supply both the insufflation gas and amedication, two suitable catheters are disclosed in U.S. Pat. Nos.6,379,373, issued Apr. 30, 2002, and 6,165,201, issued Dec. 26, 2000.The disclosure of both of these U.S. patents is incorporated herein byreference.

With the system and method described above, a physician may apply anaerosolized medicament to a distended body cavity that will allow forefficient, safe and effective application of any number of potentiallyaerosolized liquids which can be used for pain and management(analgesics), infection prevention (prophylactic antibiotics), tissueadhesion (any number of formulations can be used including naturallyoccurring lubricious medications such as hyaluronic acid, or any numberof other medicaments such as heparin, glycerin or glycol medications, oreven humidity), and tumor prevention (using targeted or prophylacticchemotherapy drugs or methods) or to control bleeding or blood clotting.Although laparoscopic procedures are specifically discussed above, thesystems and methods disclosed herein are contemplated for use in anyendoscopic or other minimally invasive procedure.

With reference to targeted or prophylactic chemotherapy, according toanother aspect of this invention, the system may be used for generalcontinued, and post-operative applications of a substance byre-instituting an environment in the patient in which subsequentapplications of the substance, such as an aerosolized medication, may beadministered. This may be accomplished by leaving a port device in thepatient after a surgical procedure, or by surgically placing a port inthe patient in preparation of a non-surgical treatment regimen. The portmay be any device capable of providing a sanitary access point to a bodycavity, where the device is a resealable mechanism that attaches to theexterior of the abdomen and the interior wall of the abdomen. Oneexample of a suitable port is an enteral feeding tube port. The portpermits the device for applying a substance to the body cavity, in thisinstance a nebulizing catheter, and the remainder of the system 10 ofFIG. 1 to be reconnected to the patient at a later time to apply thesubstance or other treatment. In one embodiment, the substance may be ananalgesic to assist with post-operative pain. In another embodiment, thesubstance may be an antibiotic for application sometime after surgery tocombat infection that may arise.

Alternatively, independently of any post-operative pain or infection, apatient may be provided with such a port for the purpose of allowing aneffective chemotherapy treatment. In this situation, a patient would beprovided with the port so that the organ or organs affected by a cancermay be directly treated with aerosol treatment customized for thatparticular patient or tumor. In either situation, post-operative reentryor chemotherapy application, treatment may be accomplished without anendoscope. In some embodiments, an endoscope may be used to allow amedical professional to properly apply the aerosol to the desired regionand so that a distal end of a nebulizing catheter may be oriented toprovide optimal aerosol placement. During the re-entry into theperitoneum, the pressure relief valve or valves (active or passive) areused to maintain a safe cavity pressure. By maintaining proper pressurewithin the peritoneum, any additional pressure introduced by the gasused in the aerosolization of the medicine, or pressure from theintroduction of fluids or other substances from outside the body cavitymay be accounted for.

As discussed above, a method and apparatus for creating a medicatedatmosphere in an organ or body cavity has been disclosed. The methodpermits a creation of an aerosol cloud allowing for the deposition of asubstance comprising a medicament on all or a selected number ofinterior surfaces. The apparatus comprises an aerosolization catheterthat can be manipulated during use, a device for the introduction of theaerosolization catheter, a medication delivery system linked to acontrol means for the control of rate, amount, and time of delivery ofthe medication, a system for providing pressure control of a gas to thecatheter which is also controlled as to pressure, timing and rate of gasflow, a means for monitoring and relieving the pressure of the gas,alone or in conjunction with an insufflator, and a means of integratingthe control of the various gas and fluid supplies for complete systemcontrol. Additionally, means for reentering the peritoneum or organpost-operatively to recreate a medicated environment for apost-operative treatment is disclosed. The insufflation and nebulizationmay both be performed through a single gas lumen in a catheter, ormultiple gas lumens, using the same regulated liquid and gas dispensingcontroller.

It is intended that the foregoing detailed description be regarded asillustrative rather than limiting, and that it be understood that thefollowing claims, including all equivalents, are intended to define thescope of this invention.

1. A method of providing repeated application of a substance to a bodycavity of a patient, the method comprising: creating a passage into thebody cavity of the patient; inserting a catheter into the body cavityvia the passage, the catheter having: a gas delivery channel configuredfor delivery of gas to the body cavity of the patient and a substancedelivery channel configured for delivery of the substance to the bodycavity of the patient, wherein the gas delivery channel and thesubstance delivery channel extend separately into, and terminate within,a distal end positionable in the body cavity; and wherein the distal endis configured to cause gas from the gas delivery channel to mix with thesubstance from the substance delivery channel outside the gas deliverychannel and substance delivery channel and within the body cavity toform an aerosol; injecting insufflation gas into the gas deliverychannel of the catheter; injecting a substance into the body cavity viathe substance delivery channel; nebulizing the substance with theinsufflation gas only inside the body cavity after the insufflation gasand the substance emerge from the distal end; and both distending thebody cavity and nebulizing the substance with only the insufflation gasinjected in the gas delivery channel.
 2. The method of claim 1, whereinthe substance is a chemotherapy drug.
 3. The method of claim 1, whereininjecting insufflation gas comprises injecting insufflation gas with aninsufflator.
 4. The method of claim 1, further comprising heating theinsufflation gas.
 5. The method of claim 4, further comprising heatingthe insufflation gas with at least one in-line gas heater.
 6. The methodof claim 1, further comprising controlling at least one of gas flow rateor substance flow.
 7. The method of claim 1, further comprising heatingthe substance.
 8. The method of claim 7, further comprising heating thesubstance with an in-line heater.
 9. The method of claim 1, whereinnebulizing the substance further comprises aerosolizing a medicament totreat at least one of pain, infection, tissue adhesion, a tumor, orbleeding.
 10. The method of claim 1, wherein injecting the substancecomprises injecting and mixing a plurality of different substances. 11.The method of claim 1, wherein injecting the substance comprisesinjecting each of a plurality of different substances consecutively. 12.The method of claim 1, further comprising maintaining a desired pressurein the body cavity with at least one pressure relief valve incommunication with one of the gas delivery channel or substance deliverychannel.
 13. The method of claim 1, wherein the substance comprises ananti-adhesive.
 14. The method of claim 1, wherein the substancecomprises an analgesic.
 15. The method of claim 12, wherein the at leastone pressure relief valve comprises one of an electrically orpneumatically controllable valve.
 16. The method of claim 12, whereinthe at least one pressure relief valve comprises a passive mechanicalvalve.
 17. The method of claim 1, further comprising executing themethod during a laparoscopic procedure.